Literature Collection

5601

Integration of mental health into PHCs in Johannesburg

Type: Journal Article

Authors: Nonceba Cynthia Sennelo

Year: 2014

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5602

Integration of mental health into primary care and community health working in Kenya: Context, rationale, coverage and sustainability

Type: Journal Article

Authors: R. Jenkins, D. Kiima, M. Okonji, F. Njenga, J. Kingora, S. Lock

Year: 2010

Publication Place: URL

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5603

Integration of mental health into primary care in Kenya

Type: Journal Article

Authors: R. Jenkins, D. Kiima, F. Njenga, M. Okonji, J. Kingora, D. Kathuku, S. Lock

Year: 2010

Publication Place: Italy

Abstract: Integration of mental health into primary care is essential in Kenya, where there are only 75 psychiatrists for 38 million population, of whom 21 are in the universities and 28 in private practice. A partnership between the Ministry of Health, the Kenya Psychiatric Association and the World Health Organization (WHO) Collaborating Centre, Institute of Psychiatry, Kings College London was funded by Nuffield Foundation to train 3,000 of the 5,000 primary health care staff in the public health system across Kenya, using a sustainable general health system approach. The content of training was closely aligned to the generic tasks of the health workers. The training delivery was integrated into the normal national training delivery system, and accompanied by capacity building courses for district and provincial level staff to encourage the inclusion of mental health in the district and provincial annual operational plans, and to promote the coordination and supervision of mental health services in primary care by district psychiatric nurses and district public health nurses. The project trained 41 trainers, who have so far trained 1671 primary care staff, achieving a mean change in knowledge score of 42% to 77%. Qualitative observations of subsequent clinical practice have demonstrated improvements in assessment, diagnosis, management, record keeping, medicine supply, intersectoral liaison and public education. Around 200 supervisors (psychiatrists, psychiatric nurses and district public health nurses) have also been trained. The project experience may be useful for other countries also wishing to conduct similar sustainable training and supervision programmes.

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5604

Integration of mental health into primary care in low- and middle-income countries: the PRIME mental healthcare plans

Type: Journal Article

Authors: C. Lund, M. Tomlinson, V. Patel

Year: 2016

Publication Place: England

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5605

Integration of Mental Health into Primary Health Care in a rural district in Uganda

Type: Journal Article

Authors: J. Ssebunnya, F. Kigozi, D. Kizza, S. Ndyanabangi, MHAPP Research Programme Consortium

Year: 2010

Publication Place: South Africa

Abstract: Objective: Mental health has been identified as a major priority in the Ugandan Health Sector Strategic Plan. Efforts are currently underway to integrate mental health services into the Primary Health Care system. In this study, we report aspects of the integration of mental health into primary health care in one rural district in Uganda. Method: Qualitative methods were used for data collection. Semi-structured interviews and focus group discussions were conducted with various stakeholders within the ministry of health as well as line ministries. Data analysis was done using Nvivo 7, specifically adopting framework analysis approach. Results: Attempts to offer organized mental health services were found to be present in only a few health facilities. The district had only a single mental health nurse, and very few General Health Workers adequately equipped with the knowledge and skills to provide mental health services. The vertical referral system was not being followed as planned and there was no evidence of any organized community interventions for those with mental disorders. The mental health nurse and a few PHC nurses however expressed interest and commitment to providing services for persons with mental illness, despite the challenges. Conclusion: Although mental health is expected to be integrated into primary health care, mental health services in this district have not yet achieved the expected level of integration. This implies that this important policy requirement has not yet been effectively realized in this rural district, which could be the case in many other districts of a similar status. There is thus a need to direct more efforts towards realization of this important policy requirement.

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5606

Integration of mental health into primary healthcare in low-income countries: Avoiding medicalization

Type: Journal Article

Authors: P. Ventevogel

Year: 2014

Publication Place: England

Abstract: Abstract Since 2008 the World Health Organization (WHO), through its mental health Gap Action Programme, has attempted to revitalize efforts to integrate mental health into non-specialized (e.g. primary) healthcare. While this has led to renewed interest in this potential method of mental health service delivery, it has also prompted criticism. Some concerns raised are that it would contribute to the medicalization of social and psychological problems, and narrowly focus on primary care without sufficient attention given to strengthening other levels of the healthcare system, notably community-based care and care on district levels. This paper discusses seven elements that may be critical to preventing inadvertently contributing to increasing a narrow biomedical approach to mental healthcare when integrating mental health into non-specialized healthcare: (1) using task shifting approaches within a system of stepped care, (2) ensuring primary mental healthcare also includes brief psychotherapeutic interventions, (3) promote community-based recovery-oriented interventions for people with disabling chronic mental disorders, (4) conceptualizing training as a continuous process of strengthening clinical competencies through supervision, (5) engaging communities as partners in psychosocial interventions, (6) embedding shifts to primary mental healthcare within wider health policy reforms, and (7) promoting inter-sectoral approaches to address social determinants of mental health.

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5607

Integration of mental health resources in a primary care setting leads to increased provider satisfaction and patient access

Type: Journal Article

Authors: K. S. Vickers, J. L. Ridgeway, J. C. Hathaway, J. S. Egginton, A. B. Kaderlik, D. J. Katzelnick

Year: 2013

Publication Place: United States

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5608

Integration of Mental Health Services by an Advanced Practice Psychiatric Nurse in a Primary Care Setting

Type: Web Resource

Authors: Rachel Rodriguez-Marzec

Year: 2016

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This grey literature reference is included in the Academy’s Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.

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5609

Integration of mental health services into an innovative health care delivery model for children with chronic conditions

Type: Journal Article

Authors: Anne Elizabeth Glassgow, Michael Gerges, Molly A. Martin, Isela Estrada, Zahra Issa, Katerine Lapin, Laura Morell, Nitza Solis, Benjamin Van Voorhees, Heather J. Risser

Year: 2018

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5610

Integration of mental health services into primary care overcomes ethnic disparities in access to mental health services between black and white elderly

Type: Journal Article

Authors: L. Ayalon, P. A. Arean, K. Linkins, M. Lynch, C. L. Estes

Year: 2007

Publication Place: United States

Abstract: OBJECTIVE: The authors evaluated whether the integration of mental health into primary care overcomes ethnic disparities in access to and participation in mental health (MH) and substance abuse (SA) treatment. METHODS: The authors conducted site-specific analysis of a multisite clinical trial to compare participation of black and white elderly in an integrated model of care (all MH/SA services are provided at primary care clinics) versus an enhanced referral model of care (all MH/SA services are provided at specialized MH clinics). In all, 183 elderly (56% black) diagnosed with depression (82%), anxiety (32%), and/or problem drinking (22%) were randomized. RESULTS: Blacks in the integrated arm were significantly more likely to have at least one MH/SA visit (77.5%) relative to blacks in the enhanced referral arm (22%; adjusted odds ratio [OR]: 14.13; confidence interval [CI]: 4.76-41.95, Wald chi(2): 22.75, df = 1, p <0.0001). There was no statistically significant difference between whites in the integrated treatment arm (66.6%) and whites in the enhanced referral arm (46.9%, adjusted OR: 2.98; CI: 0.98-9.06, Wald chi(2): 3.72, df = 1, p = 0.05). In the enhanced referral arm, blacks had a significantly smaller number of overall MH/SA visits (mean [SD]: 2.08 [5.28]) relative to whites (mean [SD]: 5.31 [7.76], adjusted incident rate ratio [IRR]: 2.87; CI: 1.06-7.73, Wald chi(2): 4.37, df = 1, p = 0.03). In the integrated arm, there was no statistically significant difference between blacks (mean [SD]: 3.22 [3.71]) and whites (mean [SD]: 2.75 [4.29], adjusted IRR: 0.58; CI: 0.25-1.33, Wald chi(2): 1.64, df = 1, p = 0.20). For both groups, time between baseline evaluation to first MH/SA visit was significantly shorter in the integrated treatment arm (for blacks: mean days [SD]: 31.06 [28.66]; for whites: mean days [SD]: 22.18 [33.88]) than in the enhanced referral arm (mean [SD]: 62.45 [43.53], adjusted hazard ratio [HR]: 7.82; CI: 3.65-16.75, Wald chi(2): 28.02, df = 1, p <0.0001; mean [SD]: 63.46 [32.41], adjusted HR: 2.48; CI: 1.20-5.13, Wald chi(2): 6.02, df = 1, p = 0.01, respectively). CONCLUSION: An integrated model of care is particularly effective in improving access to and participation in MH/SA treatment among black primary care patients.

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5611

Integration of mental health services into primary health care

Type: Book

Authors: Janvier Verfasser Rugira, Felix Mkini

Year: 2017

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This grey literature reference is included in the Academy’s Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.

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5612

Integration of Mental Health, Addictions and Primary Care

Type: Report

Authors: National Alliance on Mental Health

Year: 2011

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This grey literature reference is included in the Academy's Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.

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5613

Integration of mental health, substance use, and primary care services: Embracing our values from a client and family member perspective

Type: Report

Authors: CalMEND Client and Family Member Integration Work Group

Year: 2011

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This grey literature reference is included in the Academy's Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.

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5614

Integration of mental health/substance abuse and primary care

Type: Journal Article

Authors: M. Butler, R. L. Kane, D. McAlpine, R. G. Kathol, S. S. Fu, H. Hagedorn, T. J. Wilt

Year: 2008

Publication Place: United States

Abstract: OBJECTIVES: To describe models of integrated care used in the United States, assess how integration of mental health services into primary care settings or primary health care into specialty outpatient settings impacts patient outcomes and describe barriers to sustainable programs, use of health information technology (IT), and reimbursement structures of integrated care programs within the United States. DATA SOURCES: MEDLINE, CINAHL, Cochrane databases, and PsychINFO databases, the internet, and expert consultants for relevant trials and other literature that does not traditionally appear in peer reviewed journals. REVIEW METHODS: Randomized controlled trials and high quality quasi-experimental design studies were reviewed for integrated care model design components. For trials of mental health services in primary care settings, levels of integration codes were constructed and assigned for provider integration, integrated processes of care, and their interaction. Forest plots of patient symptom severity, treatment response, and remission were constructed to examine associations between level of integration and outcomes. RESULTS: Integrated care programs have been tested for depression, anxiety, at-risk alcohol, and ADHD in primary care settings and for alcohol disorders and persons with severe mental illness in specialty care settings. Although most interventions in either setting are effective, there is no discernible effect of integration level, processes of care, or combination, on patient outcomes for mental health services in primary care settings. Organizational and financial barriers persist to successfully implement sustainable integrated care programs. Health IT remains a mostly undocumented but promising tool. No reimbursement system has been subjected to experiment; no evidence exists as to which reimbursement system may most effectively support integrated care. Case studies will add to our understanding of their implementation and sustainability. CONCLUSIONS: In general, integrated care achieved positive outcomes. However, it is not possible to distinguish the effects of increased attention to mental health problems from the effects of specific strategies, evidenced by the lack of correlation between measures of integration or a systematic approach to care processes and the various outcomes. Efforts to implement integrated care will have to address financial barriers. There is a reasonably strong body of evidence to encourage integrated care, at least for depression. Encouragement can include removing obstacles, creating incentives, or mandating integrated care. Encouragement will likely differ between fee-for-service care and managed care. However, without evidence for a clearly superior model, there is legitimate reason to worry about premature orthodoxy.

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5615

Integration of neuropsychological assessment and intervention services into a specialty geriatric medicine clinic

Type: Journal Article

Authors: Julija Stelmokas, Christine Cigolle, Amber Rochette, Kathryn Tolle-Fu, Charles Surber, Lindsey Bloor, Pearl Lee

Year: 2022

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5616

Integration of Neuropsychological Services in a VA HIV Primary Care Clinic

Type: Journal Article

Authors: M. C. Dux, T. Lee-Wilk

Year: 2018

Publication Place: United States

Abstract: The Department of Veteran Affairs (VA) is the largest health care provider for individuals with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), with >28,000 Veterans with HIV/AIDS enrolled in care. Advances in medical treatment have improved the life-limiting effects of the disease, though many chronic symptoms persist. Comprehensive care is critical to manage the diverse constellation of symptoms. However, many patients face challenges to receiving optimal care due to limited resources, mistrust of health care providers, and/or co-occurring medical, psychiatric, and substance use disorders. The VA is a leader in developing integrated models of care to address these barriers. The inclusion of subspecialty mental health and substance abuse treatment in HIV care has been implemented across many VAs, with evidence of improved patient outcomes. However, neuropsychology has not traditionally been included, despite the fact that cognitive dysfunction represents one of the most ubiquitous complications of HIV/AIDS. Cognitive impairment is associated with myriad negative outcomes including medication non-adherence, reduced quality of life, and increased mortality. We contend that neuropsychologists are uniquely equipped to contribute to the comprehensive care of patients with HIV/AIDS. Neuropsychologists understand the range of factors that can impact cognition and have the requisite knowledge and skills to assess and treat cognitive dysfunction. Although we focus on HIV/AIDS, neuropsychologists often play critical roles in the provision of care for other infectious diseases (e.g., hepatitis C).

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5617

Integration of Neuropsychology in Primary Care

Type: Journal Article

Authors: Margaret Lanca

Year: 2018

Publication Place: United States

Abstract:

The field of neuropsychology is making inroads in primary care as the importance of cognition in physical health is increasingly acknowledged. With neuropsychology primary care integration, patients receive a range of cognitive assessments (e.g., screens, brief neuropsychological assessments, treatment recommendations through provider-to-neuropsychologist consultations) based on a stepped model of care which can more efficiently diagnose cognitive disorders/problems and assist with treatment. Two case studies are described to illuminate this process. Information is provided to illustrate how neuropsychology integration was introduced in two primary care clinics at a community-based hospital system.

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5618

Integration of neuropsychology into primary care: A retrospective analysis of outcomes and lessons learned from a single provider practice

Type: Journal Article

Authors: Robert Fallows

Year: 2019

Publication Place: Washington

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5619

Integration of pediatric mental health care: an evidence-based workshop for primary care providers

Type: Journal Article

Authors: S. D. Burka, S. N. Van Cleve, S. Shafer, J. L. Barkin

Year: 2014

Publication Place: United States

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5620

Integration of pharmacists into a patient-centered medical home

Type: Journal Article

Authors: M. A. Scott, B. Hitch, L. Ray, G. Colvin

Year: 2011

Publication Place: United States

Abstract: OBJECTIVES: To define the joint principles of the patient-centered medical home (PCMH) and describe the integration of pharmacists into a PCMH. SETTING: Family medicine residency training program in North Carolina from 2001 to 2011. PRACTICE DESCRIPTION: Mountain Area Health Education Family Health Center is a family medicine residency training program that is part of the North Carolina Area Health Education Center system. The goal of the organization is to train and retain health care students and residents. The practice is recognized as a level III PCMH by the National Committee for Quality Assurance (NCQA) and seeks to provide quality, safe, patient-centered care according to the joint principles of PCMH. Pharmacists, nurses, nutritionists, care managers, Spanish translators, and behavioral medicine specialists work collaboratively with physicians to provide seamless, comprehensive care. PRACTICE INNOVATION: The Department of Pharmacotherapy is embedded in the family medicine clinic. Three pharmacists and two pharmacy residents are involved in providing direct patient care services, ensuring access to community resources, assisting patients with transitions of care, providing interprofessional education, and participating in continuous quality improvement initiatives. The pharmacists serve as clinical pharmacist practitioners and provide medication therapy management services in a pharmacotherapy clinic, anticoagulation clinics, and an osteoporosis clinic and via an inpatient family medicine service. Multiple learners such as student pharmacists, pharmacy residents, and family medicine residents rotate through the various pharmacy clinics to learn about pharmacotherapeutic principles and the role of the pharmacist in PCMH. CONCLUSION: PCMH is a comprehensive, patient-centered, team-based approach to population management in the primary care setting. Pharmacists play a vital role in PCMH and make fundamental contributions to patient care across health care settings. Such innovations in the ambulatory care setting create a unique niche for pharmacists to use their skills.

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